Provider Demographics
NPI:1942698972
Name:ACTIVATE HEALTHCARE - LOCAL 98 CLINIC
Entity Type:Organization
Organization Name:ACTIVATE HEALTHCARE - LOCAL 98 CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEIHSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-697-3144
Mailing Address - Street 1:2010 N DAMEN AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3284
Mailing Address - Country:US
Mailing Address - Phone:773-697-3144
Mailing Address - Fax:
Practice Address - Street 1:555 HORACE BROWN DR
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1867
Practice Address - Country:US
Practice Address - Phone:248-268-4477
Practice Address - Fax:248-268-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care